Morbidity associated with coeliac disease

The lower mean levels of total cholesterol, LDL cholesterol, fibrinogen; the higher likelihood of being from more affluent social class; and the small but significant rise in HDL cholesterol and reduction in blood pressure amongst coeliacs presenting with gastrointestinal symptoms observed following treatment with a gluten-free diet suggests coeliacs have favourable vascular risk profile features in comparison to the general population. However, the higher likelihood of having abdominal truncal obesity amongst incident coeliacs that only worsens following treatment with a gluten-free diet together with the higher proportion of measured systolic hypertension amongst male coeliacs suggests that there are also potentially adverse vascular risk profile features associated with celiac disease. Though incident coeliacs with silent disease reported no change in their quality of life prior to diagnosis of coeliac disease, silent coeliacs were as likely to have villous atrophy and physiological derangement to those coeliacs presenting with symptoms or with classic features of coeliac disease. The quality of life reported by coeliacs presenting with silent disease, classic disease and with gastrointestinal symptoms was worse than that observed in the general population. A year's treatment with a gluten-free diet resulted in coeliacs having similar or in some components better quality of life than that observed in the general population. The rate of change of quality of life was similar amongst those coeliacs with silent, classic or symptomatic disease. The breast cancer risk profile suggests both protective and adverse associations of coeliac disease. The higher proportion of women being parous, having their first full-term pregnancy before 30 years and breastfeeding in addition to the younger mean age at menopause suggests women with coeliac disease have favourable breast cancer risk profile features in comparison to the general population. However, the higher likelihood of being Caucasian and of affluent social class together with higher proportion having early menarche and irregular menstrual cycles suggests there are also potentially adverse breast cancer risk profile features associated with celiac disease. Conclusions Persons with mild enteropathy disease have few physiological derangements at diagnosis of coeliac disease and show no important biochemical change following treatment with a gluten-free diet in comparison to those with severe enteropathy coeliac disease. The prevalence of hypertransaminasaemia is lower than previously reported which may be reflective of differences in study design or contemporary coeliac disease involves a milder spectrum of disease. The observed vascular and breast cancer risk profile suggests both protective and adverse associations of celiac disease and on treatment with a gluten-free diet results in an attenuation or indeed reversal of the vascular risk profile in some co-variates. Silent coeliac disease is associated with a reduction with quality in life which improves like in symptomatic and classic disease with treatment with a gluten-free diet. Incident coeliac disease is associated with more affluent social class.EThOS - Electronic Theses Online ServiceGBUnited Kingdo